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Childhood apraxia of speech (CAS) is a speech disorder in which a child’s brain has difficulty coordinating the complex oral movements needed to create sounds into syllables, syllables into words, and words into phrases. Typically, muscle weakness is not to blame for this speech disorder.

Parents of children with childhood apraxia of speech commonly say things like, "No one can understand my son," "It looks like he is trying to say the word, but can't get it out," and "He said that word one time, and then I never heard it again."

 

The most common description of a child with childhood apraxia of speech is that he is often very difficult to understand. There is something in the child's brain that does not allow messages to get to the mouth muscles to produce speech correctly.

In most cases, the cause is unknown. CAS is not a disorder that can be “outgrown,” rather children with CAS will not make progress without treatment

 

“Childhood apraxia of speech (CAS) is a neurological childhood (pediatric) speech sound disorder in which the precision and consistency of movements underlying speech are impaired in the absence of neuromuscular deficits (e.g. abnormal reflexes, abnormal tone). CAS may occur as a result of known neurological impairment, in association with complex neurobehavioral disorders of known and unknown origin, or as an idiopathic neurogenic speech sound disorder. 

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The core impairment in planning and/or programming spatiotemporal parameters of movement sequences results in errors in speech sound production and prosody. (ASHA, 2007b, Definitions of CAS section, para. 1).”

 

There are three segmental and suprasegmental features consistent with a deficit in the planning and programming of movements for speech have gained some consensus among those investigating CAS:

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• Inconsistent errors on consonants and vowels in repeated productions of syllables or words.

• Lengthened and disrupted coarticulatory transitions between sounds and syllables.

• Inappropriate prosody, especially in the realization of lexical or phrasal stress.

(ASHA, 2007b)

 

Some revealing characteristics:

Reported in children diagnosed with CAS and that represent difficulty with the planning and programming movement gestures for speech include

• articulatory groping—articulatory searching prior to phonating;

• consonant distortions;

• difficulty with smooth, accurate movement transitions from one sound to the next;

• increasing difficulty with longer or more complex syllable and word shapes;

• schwa additions/insertions—insertion of schwa between consonants or at the end of words;

• slower than typical rate of speech

• syllable segregation—pauses between sounds, syllables, or words that affect smooth transitions;

• voicing errors—voiceless sounds produced as their voiced cognates; and

• vowel errors—vowel distortions or substitutions.

 

Co-Occurring Characteristics/Symptoms

The behavioral features reportedly associated with CAS place a child at increased risk for problems in expressive language and weakness in the phonological foundations for literacy (Lewis et al., 2004; McNeill, Gillon, & Dodd; 2009b).

 

As in children with other speech disorders, co-occurring language and literacy problems can be present, including

• delayed language development.

• expressive language problems, such as word order confusion and grammatical errors;

• problems learning to read, spell, and write; and

• problems with social language/pragmatics.

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Co-occurring nonspeech sensory and motor problems can also be present (Crary & Anderson, 1991; Davis et al., 1998; Dewey, Roy, Square-Storer, & Hayden, 1988; McCabe, Rosenthal, & McLeod, 1998; Shriberg et al., 1997). These include

• gross and fine motor delays;

• motor clumsiness.

• oral apraxia;

• limb apraxia;

• feeding difficulties; and

• abnormal orosensory perception (hyper- or hyposensitivity in the oral area).

 

 

How Speech Therapy and Beyond can help:

 

Testing and diagnosis

An accurate diagnosis of childhood apraxia of speech requires a comprehensive speech and language evaluation by a speech-language pathologist (SLP). The SLP will evaluate your child's speech skills and expressive and receptive language abilities, while gathering information from your family about how your child communicates at home and in other situations.

It is important that the SLP evaluating your child has experience and expertise in diagnosing and working with childhood apraxia of speech so an accurate diagnosis can be made and other possible diagnoses are ruled out.

For example, childhood apraxia of speech is often confused with a severe articulation disorder, since both diagnoses include poor speech intelligibility. Unfortunately, the approach taken to address an articulation disorder is vastly different than the approach for childhood apraxia of speech and confusing the two could result in reduced therapy gains.

 

An assessment for childhood apraxia of speech must include an evaluation of your child's expressive and receptive language abilities; many children with this disorder demonstrate deficits in their language skills. In addition, gaps between receptive and expressive language skills, word order confusion, and difficulty with word recall are common in children with apraxia of speech. A thorough assessment of your child's abilities is needed so therapy goals can be developed based on his individual needs.

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Treatment

Treatment for apraxia of speech should be intensive and may last several years depending on the severity of your child’s disorder. Many children with childhood apraxia of speech benefit from:

• Multiple repetitions and repeated practice of sound sequences, words and phrases during therapy

• The use of visual prompting to show how speech sounds are made as sequences of sounds are combined into words

• Co-production, or having the child say the word at the same time as the SLP or caregiver

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If your child only has a limited number of words in his vocabulary, therapy will initially focus on improving his functional communication skills. It is critical for your child to have positive experiences with communication. With commitment from professionals, researchers and families, children with apraxia of speech can make significant improvements to their speech and communication skills.

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